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Comparison of different echocardiographic methods with radionuclide imaging for measuring left ventricular ejection
K Jensen-Urstad1, F Bouvier, J Höjer
1Department of Clinical Physiology, Karolinska Institute, Södersjukhuset, Sweden.
Insights
Visual echocardiography methods like wall motion scoring and ejection fraction estimation are reliable for assessing left ventricular function post-myocardial infarction, outperforming Simpson
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Accurate assessment of left ventricular (LV) function is crucial in patients following acute myocardial infarction (AMI).
- Echocardiography is a widely used tool, but the reliability of different methods for LV function assessment needs validation against reference standards.
Purpose of the Study:
- To compare the clinical utility of various echocardiographic techniques for determining LV function in recent thrombolytic-treated AMI patients.
- To compare echocardiographic measurements with radionuclide imaging, the reference standard.
- To evaluate the reproducibility of visual LV ejection fraction (EF) estimation and Simpson's rule.
Main Methods:
- Ninety-six patients with recent thrombolytic-treated AMI underwent echocardiography and radionuclide imaging within 2 hours.
- Two experienced physicians independently performed echocardiographic assessments.
- Methods included LV wall motion score index, visual EF estimation, segment counting, atrioventricular plane displacement, and Simpson's rule.
Main Results:
- LV wall motion score index (r=0.72) and visual EF estimation (r=0.71) showed the best correlation with radionuclide EF.
- Simpson's rule demonstrated low correlation (r=0.45-0.51) and was often limited by poor endocardial border visualization.
- Interobserver variability was 10% for visual EF, 18% for Simpson's rule, and 5% for radionuclide EF.
Conclusions:
- Quantitative echocardiographic methods like Simpson's rule may yield results substantially different from radionuclide imaging for EF estimation.
- Experienced sonographers can achieve reasonable agreement with radionuclide EF using LV wall motion score index or visual EF estimation.
- Atrioventricular plane measurement serves as a viable alternative for assessing LV function.
Abstract:
The aim of this study was to: (1) compare the usefulness, in clinical practice, of different echocardiographic methods of left ventricular (LV) function determination in patients with a recent thrombolytic-treated acute myocardial infarction (AMI); (2) compare these measurements with the reference method radionuclide imaging; and (3) evaluate the reproducibility of visual estimation of the LV ejection fraction (EF) and the use of the biplane method of discs (Simpson's rule) in clinical practice. Echocardiography and radionuclide imaging were performed within 2 hours of each another, 5 to 8 days after hospital admission. Ninety-six patients (70 men and 26 women) age 64 +/- 9 years (range 45 to 75) were studied. The echocardiographic study was performed by 2 experienced physicians, independently of each another. LV wall motion score index and visual estimation of the EF correlated best with the radionuclide EF (r = 0.72 and r = 0.71), thereafter simply counting the number of affected LV segments (r = 0.67) or atrioventricular plane measurements (r = 0.64). Simpson's rule had low correlation to the radionuclide EF (r = 0.45 to 0.51) and could not be used in approximately half of the patients due to poor identification of endocardial borders. The interobserver coefficient of variation for independent visual echocardiographic estimation of the EF was 10%, for Simpson's rule 18%, and for the radionuclide EF 5%. We conclude that the EF estimated from quantitative echocardiographic volume calculations (Simpson's rule) may differ substantially from radionuclide methods of measuring the EF. However, with experienced sonographers, the LV wall motion score index or visual estimation of the EF had reasonable agreement with the radionuclide EF in most of the patients. Atrioventricular plane measurement is an acceptable alternative.